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General NPI Number Information
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NPI Number | 1356508758
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Entity Type | Organization
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Legal Business Name | MICHAEL W. NOBLE, DMD, PC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 60 EAST NORTH STREET
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City | EUREKA
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State | MO
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Zip | 63025
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Country | US
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Telephone | 314-251-6725
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Fax | 314-251-6726
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Provider Business Mailing Address
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Address Line | 60 EAST NORTH STREET
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City | EUREKA
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State | MO
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Zip | 63025
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Country | US
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Telephone | 314-251-6725
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Fax | 314-251-6726
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SCOTT EDWARD GRAHAM
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Credential | MA, CMPE
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Telephone | 314-251-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | MO
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